11/1/22

Unity, not Uniformity

In a previous article, “Thoroughly Following the Path of Recovery,” I related the true story of a woman with five years of sobriety who responded to an amends letter written by the man who had killed her son in a hit-and-run accident. She said she could not describe the healing and gratitude his letter brought. She sobbed in her sponsor’s arms. “Thank you. I pray that you will keep on the path of sobriety and receive God’s love and forgiveness.” They were now in unity; they were brother and sister within the fellowship of Alcoholics Anonymous.

There are no qualifications for membership in A.A. other than the desire to stop drinking. You are a member of A.A. if you say you are. This is formalized in what is known as the Third Tradition: “The only requirement for A.A. membership is a desire to stop drinking.” This sense of unity and community is often referred to as the “We” of the Twelve Step program.

To illustrate this characteristic of recovery, addicts and alcoholics will point to the frequency with which the word “We” appears in the Twelve Steps, beginning with the first word of the First Step: “We admitted we were powerless over alcohol–that our lives had become unmanageable.” The Twelve Steps of recovery are self-consciously a first-person plural process: We are one as long as we share the desire to stop drinking.

In Twelve Steps and Twelve Traditions, within his essay on the Third Tradition, Bill W. declared that no matter who you are or how low you’ve gone, A.A. won’t deny you its fellowship. But that wasn’t always true. In the early days, because of fear and intolerance, there was an abundance of rules. “Everybody was scared witless that something or somebody would capsize the boat and dump us all back into the drink . . . We built a fine-mesh fence right around A.A.”

Experience taught them that taking away any alcoholic’s chance at membership was to potentially issue a death sentence; or to condemn him or her to endless misery. “Who dared to be judge, jury, and executioner of his own sick brother?” Two examples were given to illustrate how the early groups came to abandon all membership regulations.

One individual suffered with an unnamed dual addiction, who nevertheless easily demonstrated that he was a desperate case who above all wanted to get well. Concerned with the stigma of the man’s second addiction, they were more afraid of what others might say than the trouble this “strange alcoholic” might bring. Then someone said that what kept running through his mind was the thought: “‘What would the Master do?’ Not another word was said. What more could be said?”

Another person was a confirmed atheist who thought that A.A. could get along better without its “God nonsense.” He proceeded to remain sober and be vocal about his views. Eventually he had a slip and began drinking again. No one attempted to reach out to him. Holed up in a cheap hotel room, he thought that this was the end. Even A.A. had deserted him. “As he tossed on his bed, his hand brushed the bureau nearby, touching a book. Opening the book, he read. It was a Gideon Bible.” He didn’t drink again after the experience in the hotel room and became a valued member of A.A. What if they had succeeded in throwing him out for his blasphemy? “What would have happened to him and all the others he later helped? So the hand of Providence early gave us a sign that any alcoholic is a member of our Society when he says so.”

For by the grace given to me I say to everyone among you not to think of himself more highly than he ought to think, but to think with sober judgment, each according to the measure of faith that God has assigned. For as in one body we have many members, and the members do not all have the same function, so we, though many, are one body in Christ, and individually members one of another. (Romans 12:3-5)

Paul’s exhortation here is for us to not become prideful, to not think more highly (hyperphroneō) of ourselves than we should. In contrast, we are called to think with sober judgment (sōphroneō). The play on words in the Greek is intentional as Paul seeks to emphasize that we should not make too much of our seemingly unique and important function within the body of Christ. As members of the same body, we are given different duties or service work for the overall good of the body.

In Greek, the root word né̄phō referred to someone who avoided intoxication or was unaffected by wine. Sōphroneō then meant saneness, rationality, sober judgment. In Stoic thought, it referred to the essential virtue of proper conduct that proceeded from modesty (1 Tim. 2:9). So, Paul’s use of the various forms of né̄phō reflects the ancient philosophical belief that by practicing a particular belief system (i.e., Stoicism or Twelve Step recovery), you could put the world into proper perspective and therefore overcome it (Titus 2:12).

In other words, walk the talk and you will be able to live sober, holy lives in this present age; according to the measure of faith given to you by God. “That they were to think of themselves with ‘sober judgment’ (v. 3) suggests how out of touch with reality their opinions of themselves were. Robert Mounce said in his commentary on Romans, “Since the metaphor suggests intoxication, one might say they were in danger of becoming ‘egoholics!’”

This measure of faith is not referring to a degree of faith imparted by God, which then determines the extent of sober judgment the individual can exercise. It also does not refer to saving faith, as if there was a greater degree or richer manifestation of it meted out by God to certain believers. Paul explicitly says the opposite here: don’t fall into the trap of thinking you’re “more spiritual” than someone else. Rather, this measure refers to the specific faith given by God for the individual to fulfill his or her calling as a member of the body of Christ, since “the members do not all have the same function.”

Paul begins with an observation that it was the grace given in his function as an apostle within the body of Christ that permitted him to exhort “everyone among you” to think with sober judgment about themselves. John Murray said the role as an apostle did not make Paul more spiritual than others within the body of Christ. In effect, Paul is saying: “I’m no better than you are. And even the fact that I am telling you not to be prideful means only that I am acting on the grace given me as an apostle. I’m just another bozo on the bus.”

Just as each of us has a body made up of many parts with various functions, in Christ we who are many form one body, with each member belonging to all the others. The spiritual worship of presenting our bodies as living sacrifices (Romans 12:1) is grounded in our individual bodies being one of the many parts of the one body in Christ. So, the individual parts of the body of Christ belong to each other as do the individual parts of a physical body. And they serve each other with differing functions, just as the individual parts of a physical body.

This reference to the ‘body metaphor’ (we though many are one body in Christ) is the only instance of its use in the epistle to the Romans, but not the end of the concept in Pauline thought. Paul uses it repeatedly in Ephesians, Colossians and First Corinthians. Christ is the head of the church, which is His body (Colossians 1:18). And since the church is his body, he nourishes and cherishes it (Ephesians 5:29–30). In 1 Corinthians 10:17 we find Paul’s use of the body metaphor in his discussion of communion, “we who are many are one body, for we all partake of the one bread.” In Romans 12:5, he expands the notion that we who are many form one body by adding that we are “individually members one of another.” Believers are indeed members of one body (Colossians 3:15), which God causes to grow (Colossians 2:19).

This sense of unity in diversity, of one body with many parts (1 Co. 12:20), has certain implications and obligations. If one member denies it is a member of the body because it is not “a hand,” this denial does not make it any less a part of the body (1 Co. 12:14–15). Individual body members do not have the same function (Ro. 12:4). But they are arranged, as God desired them to be (1 Co. 12:18). We are also obliged to see that our community life in the body reflects God’s will. We are to “put off” things such as falsehood, and speak truth with our neighbors because “we are members one of another” (Ro. 12:5; Eph. 4:25). We are individually members of each other as well as in Christ. Together we have the same unity in diversity inherent within our physical bodies and when one member suffers, we all suffer; when one member is honored, we all rejoice (1 Co. 12:26). We are to put on the new self (Eph. 4:24; Col. 3:10), the armor of light (Ro. 13:12), and even the full armor of God (Eph. 6:11). And over all these virtues, we are to put on love, “which binds everything together in perfect harmony” (Col. 3:14).

This fuller exposition of the body metaphor is certainly behind Paul’s reference to the one body with many members in Romans 12:3-5, but is not needed here to make his point. By His grace, God gives each of us a measure of faith to fulfill a specific purpose within the larger body of Christ. There is a reason for our life. We are to live out this calling with the same harmony of purpose found in the organs of our own physical body.

There are several ideas in this passage and others in Romans common to Twelve Step Recovery and the sense of unity within the Fellowship. The above notion of the “We” of the program is one. Recognizing that while there are many members of A.A., they are united together. The First Tradition of A.A. says, “Our common welfare should come first; personal recovery depends upon A.A. unity.” The A.A. “Big Book” says most members sense that real tolerance of other people’s shortcomings and viewpoints and a respect for their opinions are attitudes that makes them more useful to others: “Love and tolerance of others is our code.”

Recognizing the importance of love and tolerance to other members in the Fellowship of A.A.—to other members of your spiritual, sober “body” is another. From this is a realization of the necessity to put the needs of the Fellowship-body before your own. This leads to a growing recognition of the presence of God-consciousness as the individuals and group seek to practice sober judgment in all their affairs.

If you’re interested, more articles from this series can be found under the link for “The Romans Road of Recovery.” “A Common Spiritual Path” (01) and “The Romans Road of Recovery” (02) will introduce this series of articles. If you began by reading one that came from the middle or the end of the series, try reading them before reading others. Follow the numerical listing of the articles (i.e., 01, 02, or 1st, 2nd, etc.), if you want to read them in the order they were originally intended. This article is 16^th in the series. Enjoy.

07/5/22

Surrender and Sanctification Along the Romans Road

Roman Road in Pompeii; © bloodua | 123rf.com

In chapter 12 of Romans Paul shifts from his discussion of the theological basis for faith in Christ, to a more practical discussion of how this faith should be applied in daily living. The ‘therefore’ in verse 1 suggests that what is to follow is based upon what came before. But not only does this verse refer back to the mercy discussed in Romans 11, of God bringing salvation to both Jews and Gentiles, but also to all the mercies throughout the first eleven chapters of Romans. These mercies include those we’ve looked at along the Romans Road: the mercy of God’s redemptive work Christ (Romans 3:23-25); the resulting mercy of the free gift of eternal life (Ro. 6:22-23); the mercy that this gift is available for all who believe in the person and work of Christ (Ro. 10:9-11); and the great mercy of being at peace with God (Romans 5:1).

I appeal to you therefore, brothers, by the mercies of God, to present your bodies as a living sacrifice, holy and acceptable to God, which is your spiritual worship. (Romans 12:1)

In his commentary on the book of Romans, Robert Mounce said, “These ‘mercies’ provide not only the basis, but also the incentive for all moral effort on the part of the Christian.” So, we are to consider ourselves dead to sin but alive to God in Christ. Sin should not have dominion over us (Romans 6:1-14). We are to walk according to the Spirit; not according to the flesh (Romans 8:4).

Greek philosophy often devalued the body. According to John Murray, “The ethical ideal was to be free from the body and its influences.” But this belief runs counter to a Biblical understanding of the importance of our physical nature. The degeneration of the body is the consequence of sin (cf. Genesis 2:17; 3:19; Romans 5:12), but the consummation of redemption anticipates the resurrection of the body (cf. Romans 8:23; 1 Corinthians 15:54-56). So, the renewal of our physical being is an integral part of the redemptive work of Christ. What was Paul trying to say here in Romans 12:1?

In First Corinthians (1 Corinthians 9:24-27), Paul urged Christians to discipline their bodies by self-control in all things. Here in Romans, he said we are to consider ourselves dead to sin but alive to God in Christ. Sin should not have dominion over us (Romans 6:1-14). We are to walk according to the Spirit; not according to the flesh (Romans 8:4). Therefore, we are to present ourselves “to God as instruments of righteousness” (Romans 6:13); or as he said in Romans 12:1, as a living sacrifice.

Paul uses ritual sacrifice here, common in both Jewish and Roman culture, as a conceptual metaphor to introduce how the Christian should live out their faith in Christ. An offering in Old Testament, Jewish ritual or Roman cultic practice was killed; its blood was shed. Paul turns the usual understanding on its head by saying that believers are called to a living sacrifice of their bodies.

Similar to our own time, in Roman culture there was a tendency to minimize or justify certain physical appetites as ‘normal.’ Coupled with the tendency to diminish the importance of the physical body, there was a real danger that some within the Roman church would seek to live a sinful lifestyle because they were under grace (Rom. 6:15ff). Paul was aware that if sanctification did not include the physical aspect of our being, it would be impossible to achieve. So here in chapter 12, he calls for the alignment and renewal of bodily appetites according to the will of God, and declares it to be an act of spiritual worship.

This living sacrifice is clearly voluntary, and suggests that free will has a role to play in sanctification. Surrendering our bodies as living sacrifices is a decision and we could choose to not do. As Robert Mounce noted, “Holiness of life rarely progresses apart from deliberative acts of the will. While sanctification is gradual in the sense that it continues throughout life, each advance depends upon a decision of the will.”

Living Sacrifice in the Third Step

Paul’s appeal to present our lives as living sacrifices to God in Romans 12:1 has a clear recovery parallel within the Third Step of Alcoholics Anonymous, which reads: “Made a decision to turn our will and our lives over to the care of God as we understood Him.” Here we see the same dynamic of a call or decision to turn over the living sacrifice of our will and lives to the care of God, albeit to God as we understood Him. This god is not necessarily the God of Scripture, but the language of surrender in Step Three has an echo of familiarity to the Christian. In an essay he wrote on the Third Step, Bill Wilson said, “It is when we try to make our will conform with God’s that we begin to use it rightly.” If Bill had been referring to the God of Scripture, his comment could have been appropriately applied to the Biblical call to surrender in Romans 12:1.

Using the metaphor of a closed and locked door which opens only to the key of ‘willingness,’ Wilson said that looking through it, we see an inscription beside a pathway which reads: “This is the way to a faith that works.” Faith of some kind, even if it was only in A.A. itself, was possible to anyone. “But faith alone can avail nothing. We can have faith, yet keep God out of our lives.” Wilson added that the effectiveness of the whole A.A. program rested upon “how well and earnestly” the alcoholic worked the Third Step. Even the smallest beginning of willingness was enough. Once the key of willingness was placed in the lock and the door was even slightly open, “we find that we can always open it some more.” Self-will may slam it shut, but “it will always respond the moment we again pick up the key of willingness.”

The program of Narcotics Anonymous believes “Recovery begins with surrender.” It’s Third Step Prayer says, “Take my will and my life. Guide me in my recovery. Show me how to live.” The relief of letting go and letting God helps an addict to develop a life worth living. This surrender gets easier with daily practice. “When we honestly try, it works.” But there is a caution that recognizes this is a living sacrifice: “Although we know that ‘turning it over’ works, we may still take our will and life back.”

Bill Wilson observed that simply by joining A.A., the person had made a beginning on Step Three. “Already a willingness has been achieved to cast out one’s own will and one’s own ideas about the alcohol problem in favor of those suggested by A.A.” But suppose that instinct of self-determination attempts to limit the surrender only to things involving alcohol?

“How persistently we claim the right to decide all by ourselves just what we shall think and just how we shall act.” We are confident that intelligence and willpower can control our inner lives and give us success. This philosophy of playing God sounds good, but it has to meet the acid test: “how well does it actually work?” The alcoholic learned through experience that self-sufficiency did not pay off. “Each of us had his own near-fatal encounter with the juggernaut of self-will, and has suffered enough under its weight to be willing to look for something better.” Circumstances drove them to A.A. where they admitted defeat, acquired the rudiments of faith and are now faced with the decision to turn their will and life over to a Higher Power.

As the Third Step says, we make a decision to turn our will and life over to the care of God; we become a living sacrifice. Sanctification must include our body. Our sacrifice encompasses our whole being: body and soul. For the addict or alcoholic, this alignment and renewal of their bodily appetites with the will of God includes abstinence from all mind altering and mood changing drugs. They must make this surrender.

In his daily devotional, Oswald Chambers said surrender is not the surrender of the external life, but of the will. He said one of a few great crises in life is the surrender of our will to God, who neither crushes it into submission nor pleads with us to surrender it. He waits until we yield our will to Him. According to Chambers, “That battle never needs to be re-fought.” (My Utmost for His Highest, September 13^th).

04/19/22

Recovery Is a Life-Long Process

The greatest enemy to recovery is a sense of hopelessness and helplessness: if it doesn’t seem to matter whether or not I abstain from using drugs or alcohol, why abstain? There is a similar tendency in the Christian life, as we live out the ongoing war between the desires of the Spirit and the desires of the flesh, “for these are opposed to each other, to keep you from doing the things you want to do” (Galatians 5:17). The temptation to give up, to live like a captive to the law of sin (Romans 7:23) is ever present. And the needed response in both recovery and the Christian life is spiritual tenacity or perseverance.

The importance of spiritual tenacity was emphasized in My Utmost for His Highest, for February 22^nd, “The Discipline of Spiritual Tenacity”: “It is endurance combined with the absolute certainty that what we are looking for is going to transpire.” We need to work deliberately to manifest love, justice, forgiveness and kindness to others, relying upon “the certainty that God is not going to be worsted.” We are to persevere. My Utmost for His Highest was a devotional read in early A.A.

Because of the very real correspondence between sin and addiction, spiritual tenacity or perseverance is a daily requirement for the Christian believer and the recovering alcoholic or addict. In another article, “Born of the Flesh,” I noted that addiction was simultaneously “a disease of the brain” and “an infection of the human heart.” The scientific evidence of genetics and biochemistry explains the physiological aspect of addiction, but cannot fully account for how that is translated into abnormal behavior or why the tendency to fall back into active addiction must be guarded against for a lifetime.

Increasingly in our time, materialistic cause seems to dominate accepted views of human nature and disorder. Here the bodily, material aspect of humanity is emphasized. Our mental, emotional, and spiritual lives are thought to be simply by–products of our material constitution. Therefore, explanations of human behavior have a radically naturalistic explanation. The notion of freedom, the ability to choose how we act or respond to our environment is ultimately a myth from this perspective. Moral responsibility for our actions is not something the individual can claim. Physiology, society or the environment—or a combination of these sources—is ultimately responsible for our good or bad behavior. Ultimately there is no God or Higher Power and no sin. Morality is a socially constructed phenomenon; sin does not exist; and addiction is merely a brain disease. A wonderfully complex brain disease, but ultimately caused by bio-physical mechanisms alone.

But if we are psycho-somatic beings as Anthony Hoekema claims in Created in God’s Image, we are creatures with a body (soma) and soul (psyche). Then there is an interaction between the physical and psychological aspects of our being. Genetics and biochemistry can influence human behavior, but they cannot fully determine it. If you believe that we are more than a sophisticated complex of bio-physical processes, explanations for all human behavior—including sin and addiction—must have this dual causal sense without subsuming ultimate responsibility under the other. For more on Hoekema’s idea, see “Created in the Image of God.”

Now we come to a necessary presumption, the existence of God or a Higher Power. This God or Higher Power is a necessary part of Twelve Step recovery and Christian, Biblical belief. But it is an irrelevant nuisance at best if you hold to a consistent view of addiction as merely a brain disease. When there is a God or Higher Power, there can be a basis for morality beyond human, social consensus. Wrong doing or sin can then be a violation of what this God or Higher Power declares is right. Biblical, Christian thinking goes one step further and sees sin as wrong being as well as wrong doing.

Sin is thus never merely a voluntary act of transgression; it proceeds from something more deep-seated; the expression of a sinful heart. Here the sense of sin in Romans 3:23 (all have sinned and fall short of the glory of God) and Romans 5:12-19 is in view. We are sinful in this way because the sin of Adam is imputed (credited) to all of us. Rejecting the doctrine of original sin fails to appreciate the close relationship between the imputation of Adam’s sin to all of humanity and God’s plan for the accomplishment of salvation in Christ. In the New Bible Dictionary, John Murray and B.A. Milne said:

The history of mankind is finally subsumed under two complexes, sin-condemnation-death and righteousness-justification-life. The former arises from our union with Adam, the latter from union with Christ. These are the two orbits within which we live and move. God’s government of men is directed in terms of these relationships. If we do not reckon with Adam we are thereby excluded from a proper understanding of Christ. All who die die in Adam; all who are made alive are made alive in Christ.

So that which is born of the flesh (the physical body) is flesh (a depraved heart, given over to wickedness). Addiction is simultaneously a disease of the brain and an infection of the heart. And this bio-psycho-social-spiritual ‘disease’ precedes the addictive/sin behavior noted in Romans 7:18-19: “For I have the desire to do what is right, but not the ability to carry it out. For I do not do the good I want, but the evil I do not want is what I keep on doing.”

Like sin, addiction is wrong being as well as wrong doing. And the wrong being of addiction has an ongoing existence in the human heart that continually strives to re-engage the addict or alcoholic in the wrong doing of active drinking or drug use. So, it’s not enough to simply abstain from drugs or alcohol; the addict has to change: Abstinence plus change equals recovery. And this change process must be a lifelong pursuit.

Walking Up the Down Escalator

One metaphoric image that captures this truth is to say that recovery is like walking up a down escalator. The trick for progress is to continue walking up the escalator faster than it is moving down. It doesn’t matter how long you have been walking up the escalator, the moment your efforts to walk up are less than the down movement of the escalator, you start to drift back to where you started. You may even continue to walk up; but if the effort isn’t greater than the movement of the down escalator, you don’t even realize you are actually moving backwards. For more on this concept, see “Preventing the Relapse Process, Part 2.”

In the AA Grapevine article, “PO Box 1980,” was the story of an older man at a treatment center. He approached a counselor after a talk on relapse and said that until two weeks before that, he had been sober for forty-two years. For thirty-nine of them, he attended A.A. meetings. After he moved three years ago, he stopped going to A.A. when he found that he just didn’t like the meetings in his new area. He figured he’d heard all he was going to hear and learned all he was going to learn; that he didn’t need them after thirty-nine years.

On an ordinary day, when a couple of things went wrong, he thought he would feel better with a drink. “That first day I only had a couple, but the next day I drank until I passed out. I disappeared for two weeks and my grandkids came looking for me. They found me passed out in a closet and they brought me here.” Abstinence relieves the symptoms of wrong doing, but it does not cure the disease of addictive wrong being. Recovery is a life-long process.

01/11/22

The Cost of Buprenorphine-Assisted Recovery

niceideas | 123rf.com

As I was leaving a rescue mission in Pittsburgh, I saw a homeless man curled up in a fetal position in front of the building. He was unresponsive when I called out to him, so I went back inside and told someone to call 911. While I was doing this, another staff member got Narcan and administered it to the man. When the paramedics arrived, they were eventually able to convince him to go to the emergency department of a local hospital. But he refused further treatment services there and was released.

This is a typical response of those who experience a nonfatal opioid overdose. According to Davis et al in an article published in the Annals of Emergency Medicine, opioid users resist treatment with buprenorphine even though it significantly reduces overdose mortality. In an attempt to minimize this treatment void, some EMS paramedic units are administering buprenorphine to patients almost immediately after reviving them from an opioid overdose. STAT reported back in June of 2019 that New Jersey’s health commissioner authorized paramedics to offer the drug to patients after their overdose has been reversed with naloxone.

The first-in-the-nation model has a twofold purpose, health officials said: Beyond treating the withdrawal symptoms that can result from a naloxone revival, administering buprenorphine on scene could serve as an immediate transition to longer-term treatment.

Dr. Dan Ciccarone, a professor who studies heroin use and the opioid epidemic, said while the prehospital use of buprenorphine comes out of left field, “It’s a potentially brilliant idea.” He sees this as an attempt to treat the person in as well-meaning and patient-centric way as possible. “And that means naloxone plus a softer landing with buprenorphine.” Doctors in numerous emergency departments already prescribe buprenorphine in an effort to provide relief after reversing an overdose. Extending that ability to paramedics “is a new frontier.”

As a safeguard, New Jersey’s 1,900 paramedics will need to obtain permission from the emergency physician overseeing their unit before administering buprenorphine when responding to an overdose call. The supervising physician must have a DEA waiver [and undergo training] to prescribe buprenorphine, a spokeswoman said.

We need to think beyond how we’ve traditionally treated nonfatal opioid overdoses. A CDC press release indicated in the 12-months ending in April 2021, the estimated overdose deaths from opioids increased from 56,064 in April of 2020 to 75,673. Overall drug overdoses increased 28.5% during the same period of time. An interactive web dashboard is available and can gives you predicted overdose data for individual states. The overall increase in overdoses for the United States is 28.5%.

Pennsylvania was among the states hardest hit by the opioid epidemic. In 2018, it had one of the highest death rates from drug over doses, with 65% of 2,866 fatalities involving opioids. Policy responses made to mitigate the spread of COVID-19 in Pennsylvania made the problem worse. Analysis of data from the Pennsylvania Overdose Information Network for both fatal and nonfatal overdoses revealed statistically significant increases across some of the populations most affected by opioids before the pandemic.

In “Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses,” the authors said the stay-at-home order in Pennsylvania contributed to a statistically significant increase in opioid overdoses compared with preceding months. See “Unintended Consequences of COVID-19” for more on this topic. It seems this increase in opioid overdoses may have partly motivated Pittsburgh to become only the third city in the country to announce a pilot group of Emergency Medical Services (EMS) paramedics that will administer prehospital buprenorphine.

On November 22, 2021, The Office of Community Health and Safety in Pittsburgh announced paramedics had completed training to administer prehospital buprenorphine and began implementing the practice over the weekend before Thanksgiving. In September, the Pennsylvania Department of Health Bureau of EMS approved the Prehospital Buprenorphine Pilot Program for the City of Pittsburgh’s EMS. The pilot program was designed by the Bureau of EMS in partnership with the Office of Community Health and Safety.

As part of the pilot, Advanced Life Support EMS units will be able to administer buprenorphine to patients experiencing opioid withdrawal regardless if that patient decides to go to the hospital. Patients will then be able to schedule a virtual follow up with the UPMC Medical Toxicology Bridge Clinic to have a consultation with a doctor within 24 hours to get a buprenorphine prescription and be connected to other critical harm reduction resources.

Advanced Life Support EMS units will be able to administer buprenorphine to patients experiencing opioid withdrawal regardless of whether they decide to go to the hospital. Patients will then be able to schedule a virtual follow up to have a consultation with a doctor within 24 hours in order to get a buprenorphine prescription and be connected to other harm reduction resources.

The mayor of Pittsburgh, Bill Peduto, said: “The opioid epidemic has deeply affected so many cities and communities. If tools like buprenorphine exist, we need to have them in our communities and with our emergency medical personnel.” The Pittsburgh Post-Gazette reported there has been a 58% increase in overdose-related calls between October of 2020 and July of 2021—the latest month the city had data on. See the following chart showing the drug overdose calls to EMS in Pittsburgh.

Research shows that buprenorphine-assisted recovery from opioid use decreases the likelihood of recurrent overdoses and death from overdoses while increasing the likelihood of the person engaging in recovery. Dr. Jody Glance said buprenorphine helps patients more comfortably stop using opioids by alleviating their withdrawal symptoms. “Once the person is stabilized on the medication, they will not have the same level of cravings or desire to use illicit opioids.” This stabilization allows the person to engage in activities to support their ongoing recovery.

Dr Glance said some people remain on buprenorphine because they believe it is saving their life. “A lot of people find that the medication is so helpful, that coming off of it is more risky than staying on it.” She added that sometimes people stay on buprenorphine for a long time. Like other chronic, relapsing illnesses, “with opioid use, a lot of times people need a medication on a more long-term basis.” For patients who want hospital treatment, the program allows them to schedule a follow up visit with The UPMC Medical Toxicology Outpatient Clinic to continue taking the drug.

While it is an amazing, almost miraculous tool, bringing relative stability to the lives of opioid addicts, it comes with a price. Buprenorphine is itself an opioid. The DEA classifies it as a Schedule III controlled substance. It’s effectiveness in alleviating withdrawal and minimizing cravings for licit and illicit opioids is based on this pharmacological fact. And long-term use of buprenorphine perpetuates some of the same neurochemical actions found in opioid use disorder.

In her book, Never Enough, Judith Grisel introduced what she said were the three laws of psychopharmacology. They are: 1) all drugs act by changing the rate of what is already going on in the brain; 2) all drugs have side effects; and 3) the brain of someone who misuses drugs adjusts by producing fewer neurotransmitters in the reward circuit, or by reducing the number of receptors that can receive signals. The psychopharmacological action of buprenorphine-assisted recovery on the brain continues to activate these principles.

Not only do we need to bring stability to the lives of addicts after a nonfatal overdose, we need to educate them about the potential consequences they face with long-term use of buprenorphine. Inform them of the cost they’ll pay for a buprenorphine-assisted recovery.

For more information on Judith Grisel and the significance of the three laws of psychopharmacology to addiction recovery, see “Never Enough and No Free Lunch” and “Never Enough and Adaptation.”

12/14/21

The Common Grace of Recovery

Regardless of the influence of genetics, personal history, or environment, Twelve Step recovery is centered upon the hope that the addict or alcoholic can actually choose to establish and then maintain abstinence from drugs and alcohol. Powerless they may be over the influence these substances exert over them once the substance is coursing through their veins, but the individual is not powerless over the decision to ingest the substance. In order to recover, the addict or alcoholic must believe that they can really choose to not pick up a drink or a drug; and that they can surrender their life to the God of their understanding. They are powerless over alcohol and drugs, but not the decision to use them.

The central fact of our lives today is the absolute certainty that our Creator has entered into our hearts and lives in a way which is indeed miraculous. He has commenced to accomplish those things for us which we could never do by ourselves.

As explicit as this statement in the A.A. Big Book seems to be, the spiritual relativity of the Twelve Steps meant that “our Creator” could be a variety of things; and often meant the recovery program itself. Narcotics Anonymous said this explicitly in their basic text: “It wasn’t until we came to Narcotics Anonymous that recovery became possible. This program can do for us what we could not do for ourselves.” The author of “What We Could Never Do” in the AA Grapevine used language reminiscent of an individual testifying of their “born again” experience. They said: “The central fact of my life today is the absolute certainty that AA has entered into my heart and life in a way which is indeed exceptional.”

This postmodern avoidance of absolutes, especially about God, was firmly embedded in Twelve Step recovery from the beginning. The recovery program described in the A.A. Big Book was merely suggestive. Although God existed, you didn’t have to believe in him all at once; and could even fashion your own understanding of a “Higher Power.” The ability to imagine God as you understand Him has remained a hallmark of the spiritual worldview of A.A.

In a 1949 address before the American Psychiatric Association, Bill Wilson explicitly stated that A.A. was not a religious organization because it had no dogma. He also stated that the only theological proposition—of a Power greater than one’s self—would not be forced on anyone. There was a self-conscious avoidance of the absolute certainty with which the apostle Paul declared that everyone who calls on the name of the Lord will be saved. Even while acknowledging the parallels to religious conversion within the recovery program of A.A., Wilson said that too many people were afraid of being “God-bitten.”

In 1961, Wilson said the following in “The Dilemma of No Faith” for the AA Grapevine: “Our concepts of a Higher Power and God—as we understand Him—afford everyone a nearly unlimited choice of spiritual belief and action.” He suggested that this was perhaps the most important expression in be found in the entire vocabulary of A.A. Every kind and degree of faith, together with the assurance that each person could choose his or her own version of it opened a door “over whose threshold the unbeliever can take his first easy step into . . . the realm of faith.” So, recovery does not require that you acknowledge and worship Jesus Christ as your Higher Power. At this point, Twelve Step recovery wanders off in a different direction from the Romans Road.

Confess and Believe

If you confess with your mouth that Jesus is Lord and believe in your heart that God raised him from the dead, you will be saved. For with the heart one believes and is justified, and with the mouth one confesses and is saved. For the Scripture says, “Everyone who believes in him will not be put to shame.” For there is no distinction between Jew and Greek; for the same Lord is Lord of all, bestowing his riches on all who call on him. For “everyone who calls on the name of the Lord will be saved.” (Romans 10:9-13)

Here is one of the classic summaries of the fundamental elements of faith leading to salvation. The confession of Jesus as Lord here refers to the position Christ has because he ascended into heaven and sits at the right hand of the Father, where he was given authority over all of creation (Ephesians. 1:20-23). The order Paul uses in verse 9 (mouth and heart) corresponds to the order of Deuteronomy 30:14, which he just quoted; but then he reverses that order (heart and mouth) in verse 10. Paul is not presenting a recipe or magical formula for salvation. Rather, he is emphasizing the central importance of believing in your heart for the process of salvation, for everyone who believes in him will not be put to shame.

There is a principle in Scripture with regard to human nature that inexorably links heart and behavior: whatever rules your heart rules your behavior (Matthew. 6:21; Luke 6:45). So here we see that even in salvation, this principle applies: we believe in our heart and confess with our mouth. In his commentary on Romans, John Murray said: “Confession verifies and confirms the faith of the heart. . . Confession with the mouth is the evidence of the genuineness of faith.” This is equivalent to the discussion of faith in works in James 2:17-22. Faith without works (behavior that does not proceed from faith) is dead.

The Big Book described in chapters five and six how the program of recovery embodied in the first eleven of the Twelve Steps works. It ends with these words: “But that is not all. There is action and more action. ‘Faith without works is dead.’The next chapter, “Working with Others,” is entirely devoted to Step Twelve. It suggested the “works” for the practitioner of the Twelve Steps was carrying the message to others. The spiritual experience of faith in the first eleven Steps should lead to helping others. Step Twelve says: “Having had a spiritual awakening as the result of these steps, we tried to carry the message to alcoholics, and practice these principles in all our affairs.” Without citing the biblical origin of the quote, Bill Wilson relayed a saying that had relevance to his own recovery and almost played a role in the naming of A.A. itself.

Bill Wilson lived with Dr. Bob Smith and his wife Anne for about three months after he first met Dr. Bob in Akron, Ohio. Every morning they would have a devotional time in which Anne would read from the Bible. The book of James was a favorite; and Anne would conclude their devotional time by saying, “Faith without works is dead.” Not only was this a favorite quotation of Anne Smith, but the book of James was a favorite with early AA’s– “so much so that ‘The James Club’ was favored by some as a name for the Fellowship.”

Paul makes the same connection between faith and works in Romans 10:9-10. Faith, believing in your heart that God raised Jesus from the dead, without works, confessing with your mouth that Jesus is Lord is dead faith. But “if you confess with your mouth that Jesus is Lord and believe in your heart that God raised him from the dead, you will be saved.” Paul drives this point home in his repeated use of the Greek word gar, (commonly translated as “for”) four consecutive times in verses 10 through 13 of Romans 10. By doing so, he explains the declaration he just made in verse 10:9, that if you confess with your mouth (that Jesus is Lord) and believe in your heart (that God raised him from the dead) you will be saved.

Common Grace and Recovery

How do you obtain salvation? According to Romans 10:9, by believing in your heart and confessing with your mouth that Jesus is Lord. How do you obtain recovery? By a surrender to a god of your understanding, fashioned from the knowledge of God revealed in creation (Romans 1:19-25). You can use ritual and language with strong similarities to the ritual and language of those claiming a relationship with Christ, but it’s not the same.

You can be “reborn”; you can believe that your Creator has entered your heart and begun to accomplish things you could not do for yourself. But if this does not rest on the foundation of Jesus Christ it is not salvation in the Biblical sense. The spiritual and theological differences between the two are radical. Biblically speaking, a self-fashioned understanding of God is idolatry since you worship and serve some aspect of creation that manifests “the depth of the riches and wisdom and knowledge of God” (Romans 11:33) instead of God himself.

In the “We Agnostics” chapter of the A.A. Big Book, Bill Wilson wrote that deep down inside us was the fundamental idea of God. Faith in some kind of God was a part of our human make-up. “Sometimes we had to search fearlessly, but he was there. He was as much a fact as we were. We found the Great Reality deep down within us.”

Humans beings are naturally in possession of rational and moral abilities. Because of the Fall, these abilities are used in ways that are hostile to serving and glorifying God. But this capacity for rationality and morality has not been diminished through sin. We are not irrational or amoral in this sense as a consequence of the Fall. Through sin we fell ethically and became hostile to God.

A Fallen, sinful person has no ability (they are powerless) to keep that hostility from becoming consistent and full blown. At it says in Romans chapter 7, we can have the desire to do good, but not the ability to carry it out. We are captive to the law of sin inside of us. But there is common grace, which is: “The means by which God keeps [us] from expressing the principle of hostility to its full extent, thus enabling [us] to do the relative good.”

Common grace is then a restraining force that keeps us from being completely hostile towards God, whether or not we believe in Him; whether or not we have a Romans 10:9 relationship with Jesus Christ. The addict or alcoholic is powerless over addiction because it is a manifestation of his or her hostility to God. Apart from the common grace of God within the Twelve Steps, they express this hostility in the horror of their active addiction—independent of their faith or lack of faith. Yet, through God’s common grace, even an atheist or agnostic can stop their previously active addiction.

A self-described atheist went on a week-long drinking binge after three and a half years of abstinence. Returning to her home group, she said she prayed twenty times a day to a God she didn’t believe in to please help her to not drink: “Please, God, if you are there, do not let me do it to myself again. After six months of believing I would never be able to stay sober again, I finally lost the obsession to drink.” She said it took her twenty years to “stop fighting God and to surrender.” She cleaned up her mouth; learned to have relationships; and “found a new friend in God.”

The ‘miracle’ of being relieved of the obsession to drink is accomplished through the common grace of God. And this grace is equally available to those who turn to the program of A.A. or N.A. as their Higher Power as it is for those with a Romans 10:9 relationship with Jesus Christ. God “makes his sun rise of the evil and on the good, and sends rain on the just and the unjust” (Matthew 5:42).

10/29/19

Do They Walk Their Talk?

Matthew 7:15 cautions us to “Beware of false prophets.” By their external appearance, they look authentic and may even do or say some of the right things. Like wolves in sheep’s clothing, they appear to be the real deal on a superficial level, but inwardly they are vicious and destructive. So how can you tell a true prophet from a false one? The answer is, do they bear good fruit—do they walk their talk?

The concluding section of the Sermon on the Mount makes use of the “Two Ways” tradition of early Christianity and Judaism. In three illustrations, Jesus plainly showed there are only two categories of people in the world—those who enter by the narrow gate rather than the wide gate (vv. 13-14), those who bear good fruit rather than bad (vv. 15-20), and those who build their homes on solid rock rather than shifting sand (vv. 24-27). In his commentary Leon Morris commented, “In each case the first category refers to those who hear, obey, and are saved; the second, to those who only hear and so are destroyed.” In other words, not everyone who says they are a Christian, is a Christian. They have to show it.

¹⁵“Beware of false prophets, who come to you in sheep’s clothing but inwardly are ravenous wolves. ¹⁶You will recognize them by their fruits. Are grapes gathered from thornbushes, or figs from thistles? ¹⁷So, every healthy tree bears good fruit, but the diseased tree bears bad fruit. ¹⁸A healthy tree cannot bear bad fruit, nor can a diseased tree bear good fruit. ¹⁹Every tree that does not bear good fruit is cut down and thrown into the fire. ²⁰Thus you will recognize them by their fruits. (Matthew 7:15-20)

The contrast of the two ways is not found in the other gospels, but it does appear in the Old Testament (Deuteronomy 30:19; Psalm 1:6, Jeremiah 21:8); in Jewish writings (2 Esdras 7:6-13); and in early Christian literature, like Didache 1:1: “There are two ways, one of life and one of death, and there is a great difference between the two ways.” Some may verbally affirm that Jesus is Lord, and even preach the gospel, but inwardly are insatiably after their own interests. They are like ravenous wolves. So how can you tell who is a wolf in sheep’s clothing? By their fruits: “Their fruits will in the end betray them.”

Jesus used an illustration from the everyday life of his audience to demonstrate this. Everyone knew that the buckthorn had small black berries that could be mistaken for grapes. And there was a thistle whose flower could be mistaken for a fig, from a distance. However, as D.A. Carson said, “But no one would confuse the buckthorn and the grape once he started to use the fruit to make some wine. No one would be taken in by thistle flowers when it came to eating figs for supper.” The same principle is true of trees—a good tree bears good fruit; a diseased tree bears bad fruit.

Here the thought is that it is not the outward appearance that is important (wolves may be dressed up to look like sheep), but the things the false prophets do, the produce of their manner of thought and life. If the disciples take note of what these false prophets do and refuse to be charmed by their false words, they will recognize them for what they are.

If a tree is healthy, it cannot bear bad fruit. Conversely, a diseased tree cannot bear good fruit. The repetition emphasizes the point. Then Jesus moved to the fate of every diseased trees: “No bad tree is allowed to continue producing its bad fruit.” The consequence is universal; it is cut down and burned.

The burning of a worthless tree removes the possibility that it will infect other trees. But fire is often used of the fire of hell, and this meaning may be not far away. Jesus is making it clear that discipleship means a great deal more than religious activity.

So then, the logical conclusion of Jesus’ teaching here is a repetition of verse 16. “You will recognize them by their fruits.” The good fruit of a person’s life is the evidence of their claim to be a prophet. And since good fruit cannot grow on a diseased tree, you can discern a false prophet by their fruit as well. False prophets, like diseased trees, should be cut down and thrown into the fire.

The Old and New Testaments contain multiple warnings against false prophets. They commit adultery, walk in lies and strengthen the hands of evil doers (Jeremiah 23:14); they are treacherous and do violence to the law (Zephaniah 3:4); they prophesy lies in the name of God, the deceit of their own minds (Jeremiah 14:14). The Bible suggests these false declarations come from their own hearts (Ezekiel 13:2, 4; Jeremiah 23:16, 26). We can suggest that at least one of the ways to uncover a false prophet is to watch and see if they demonstrate their love for God by walking their talk. But what if the false prophet is a wolf in sheep’s clothing—what if they appear good on the outside?

There is a root and fruit connection to our actions (fruit) and our heart (root). A “healthy tree bears good fruit, but the diseased tree bears bad fruit.” The parallel to our Matthew passage in Luke 6:43-45 declared the good person produces good treasure from his heart and the evil person produces evil treasure from his heart, “for out of the abundance of the heart his mouth speaks.” In Instruments in the Redeemer’s Hands, Paul Tripp illustrated this process in his discussion of fruit stapling, where efforts to change behavior ignore the heart behind the actions.

Drawing on the fruit tree metaphor in the Luke passage, he asks us to imagine that he has an apple tree in his backyard. Year after year the apples are dry, wrinkled, brown and pulpy. His wife says it doesn’t make any sense to have an apple tree that doesn’t produce good fruit and suggests that Paul cut down the tree and burn it. Instead, he buys branch cutters, an industrial grade staple gun, a ladder and two bushels of apples. He climbs the ladder, cuts off all the pulpy apples, and staples shiny red apples on every branch of the tree. “From a distance our tree looks like it is full of a beautiful harvest.”

If a tree produces bad apples year after year, there is something drastically wrong with its system, down to its very roots. I won’t solve the problem by stapling new apples on the branches. They also will rot because they are not attached to a life-giving root system. And next spring, I will have the same problem again. I will not see a new crop of healthy apples because my solution had not gone to the heart of the problem. If the tree’s roots remain unchanged, it will never produce good apples.If my heart is the source of my sin problem, then lasting change must always travel through the pathway of my heart. It is not enough to alter my behavior or to change my circumstances. Christ transforms people by radically changing their hearts. If the heart doesn’t change, the person’s words and behavior may change temporarily because of an external pressure or incentive. But when the pressure or incentive is removed, the changes will disappear.

Sooner or later they will show the wolf; a diseased tree always bears bad fruit. They cannot consistently walk the talk because the seemingly “good fruit” does not come from a changed heart.

The root-and-fruit principle applies readily to 12 Step recovery. Several of the sayings used in recovery, such as walking your talk, he’s on a dry drunk, you can’t be clean while living dirty, are illustrations of it. It even applies to judging your spiritual experiences and whether or not you can ever ‘get’ clean.

Bill W. wrote an article originally published in the Grapevine in July of 1962, “Spiritual Experiences.” It was later added to a collection of his Grapevine writings, The Language of the Heart. He said he was the recipient of a tremendous mystic experience in 1934 that was “accompanied by a sense of intense white light, by a sudden gift of faith in the goodness of God, and by a profound conviction of his presence.” He said in retrospect, the only special feature was its electric suddenness and the overwhelming and immediate conviction that it carried to him. “In all other respects, however, I am sure that my own experience was not in the least different from that received by every AA member who has strenuously practiced our recovery program.”

He said when a person approached him to find out how to have a sudden spiritual experience, he tells them that in all probability they have had one just as good, except it was strung out over a longer period of time. If a spiritual transformation over six months had been condensed into six minutes, “well they then might have seen the stars, too!” He failed to see any great difference between the sudden and more gradual experiences; they were certainly all of the same piece. The one sure test of any spiritual experience was, “By their fruits, ye shall know them.”

As Bill Sees It is a collection of selected writings by Bill W. In there was an excerpt from a 1958 letter Bill wrote to a person discouraged over repeated “slips,” lapses back into active drinking. The discouraged individual was thinking of not returning to A.A. because of his lapses. Bill advised him against staying away from A.A. because of feeling of discouraged or shameful of his lapses. “It’s just the place you should be.”

For some reason, Bill said, the Lord seemed to have him on a tougher path. But God was not asking for him to be successfully abstinent, “He is only asking us to try to be.” Here was the key feature in achieving lasting abstinence—a transformed heart; a surrender of your will and life to God after recognizing your powerlessness to do so in your own strength. And whether this spiritual experience was sudden or gradual, the sure test of whether it was real was by its fruit. If there was a true surrender, he would get the program. “It is not always the quantity of good things that you do, it is also the quality that counts.”

This is part of a series of reflections dedicated to the memory of Audrey Conn, whose questions reminded me of my intention to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”

11/27/18

I Must Have Another Drink!

If we suppress the “fundamental idea of God” that lies within us, then God gives us up to the lusts of our heart. There is war between the flesh and the spirit; we don’t do what we want to do; our lives become unmanageable. We are powerless over sin—and if that powerlessness involves mind-altering substances, alcohol or drugs becomes our god. As Paul quotes in a flurry of verses beginning at Romans 3:10: “as it is written: None is righteous, no, not one; no one understands; no one seeks for God. All have turned aside; together they have become worthless; no one does good, not even one. “All have sinned and fallen short of the glory of God.” (Romans 3:23)

Although we are powerless over sin, God has provided a way out through faith in Jesus Christ. And this righteousness is available for all who believe. In his commentary on Romans, John Murray said: “There is no discrimination among believers—the righteousness of God comes upon them all without distinction.” The Old Testament itself (the Law and the Prophets) bears witness to this. In fact, it can be shown that God had this plan for salvation in mind even before the sin of Adam and Eve.

But now the righteousness of God has been manifested apart from the law, although the Law and the Prophets bear witness to it— the righteousness of God through faith in Jesus Christ for all who believe. For there is no distinction: for all have sinned and fall short of the glory of God, and are justified by his grace as a gift, through the redemption that is in Christ Jesus, . . . (Romans 3:21-24)

The root meaning of the Greek word for redemption is to deliver by paying a price. So our deliverance from sin through Jesus Christ is more like a ransom than liberation. We were bought at a price and not simply liberated from the concentration camp of sin and death. So there is a contrast here between the freely given gift of grace and the costliness of the ransom paid by Christ to release us.

Not only have all sinned and fallen short of the glory of God, but all are justified by grace, free of charge, through the redemption in Christ Jesus. “By his grace as a gift” emphasizes the unmerited nature of God’s justification and is the solution to the conclusion of verse 3:20, namely that “by works of the law no human being will be justified.” Nothing we do, not even what we possess as creatures made in His image, can predispose God to cause us to be free from sin and in right relationship with Him. Yet He gives it freely as a gift.

. . . whom God put forward as a propitiation by his blood, to be received by faith. This was to show God’s righteousness, because in his divine forbearance he had passed over former sins. It was to show his righteousness at the present time, so that he might be just and the justifier of the one who has faith in Jesus. (Romans 3:25-26)

Here the gospel and mere recovery take different paths, because of the significance of Christ for salvation. Both the gospel and recovery can acknowledge the powerlessness we have over sin (addiction), but Paul asserts that our release from sin was at the cost of Jesus’ death as an atoning sacrifice. In mere recovery there is no redeeming sacrifice; no ransom paid for the release from addiction. Faith in God to deliver from addiction leads to a liberation from addiction, but not to the redemption that is in Christ Jesus.

This idea of a costly ransom is further asserted in referring to Christ Jesus as a propitiation in verse 25. The Greek word used here is only found one other time in Scripture, in Hebrews 9:5 where it refers to the mercy seat, the covering over the Ark of the Covenant. On the Day of Atonement, Yom Kippur in modern Jewish worship, the high priest would enter into the Holy of Holies and sprinkle the mercy seat with the blood of a sacrifice to make atonement for the sins of all the people (Leviticus 16). The sprinkling of blood over the mantle of the homes of the Israelites was also done so that the angel of death would “pass over” their homes as it brought judgment to Egypt (Ex. 12:1-20). The Passover meal celebrates this deliverance.

So Paul is presenting Jesus Christ as the redeeming sacrifice that takes away the sins of all who believe in him. Our sins are atoned for because of the blood of his sacrifice.

Paul has been unpacking several phrases in these last few verses; and he does so again in verse 3:26. The righteousness of God in verse 21 is noted to be the righteousness of God through faith in Jesus Christ in verse 22. The redemption (ransom) in Christ Jesus noted in verse 24 was specified to be a result of our willingness to believe that he was the true expiatory sacrifice (verse 25). Not only was this to show the righteousness of God because He passed over our former sins (verse 25), but that God did so at this present time, in Christ Jesus (verse 26), because there was no other way. In Jesus Christ alone do we receive forgiveness of our sins and justification from God. Jesus himself was not only righteous, but also the one who declares that all who have faith in him are righteous themselves.

Notice the similarity between the powerlessness over sin noted above and how Bill W. described the powerlessness over alcoholism faced by the alcoholic in the “Step One” essay of Twelve Steps and Twelve Traditions: “Every natural instinct cries out against the idea of personal powerlessness. It is truly awful to admit that . . . we have warped our minds into such an obsession [for destructive drinking] that only an act of Providence can remove it from us.”

In Twelve Step recovery there is a saying that once you are powerless over addiction, continued drug and alcohol use will ultimately lead to jail, institutions, or death. There is no hope for an addict or alcoholic who remains in an active addiction. Ultimately, they will die in their addiction. Some sociologists even liken addiction to indirect suicide. But sometimes, the suicidal impulse is more direct. Here is a quote from “An Inner Truth,” from the AA Grapevine:

One night, I decided that I couldn’t live with alcohol anymore–but I couldn’t live without it. So, I devised a fail-proof plan to take my life. I took a vacuum hose and connected it to the exhaust of my truck, taped and sealed the windows, started the truck, finished my fifth (I wouldn’t want to leave any behind), and prepared to die. I awakened the next morning in my truck, very sick, with an empty fifth, and very much alive. I looked at the gas gauge and there was still a quarter tank of gas left. The key was in the “on” position and the fail-proof plan had failed. The truck died during the night, and I didn’t. Somehow, a few months later, I ended up at an AA meeting sitting across the table from a man who had attempted suicide with a shotgun and blown his face off. He looked across the table at me and said, “Welcome,” and then, “Boy, you look like crap.” Coming from a man without a nose and a lot of facial damage, this statement stuck in my mind.

Proverbs 23:29-35 captures the clear cycle of unmanageability in alcoholism. It explicitly describes the spiral of progressive sin in alcoholism:

Who has woe? Who has sorrow? Who has strife? Who has complaining? Who has wounds without cause? Who has redness of eyes? Those who tarry long over wine; those who go to try mixed wine. Do not look at wine when it is red, when it sparkles in the cup and goes down smoothly. In the end it bites like a serpent and stings like an adder. Your eyes will see strange things, and your heart utter perverse things. You will be like one who lies down in the midst of the sea, like one who lies on the top of a mast. They struck me, you will say, but I was not hurt; they beat me, but I did not feel it. When shall I awake? I must have another drink.

In My Utmost for His Highest (which was used by early members of A.A), Oswald Chambers noted there is something in human nature that laughs in the face of every ideal you have. “If you refuse to agree with the fact that there is vice and self-seeking, something downright spiteful and wrong in human beings, instead of reconciling yourself to it when it strikes your life, you will compromise with it and say it is of no use to battle against it.” So it’s not just that we do wrong things—that we sin, drink or use drugs—but that there is something in human nature that is opposed to our ideals.

There is something within us that seeks to resist the good we want to do. Sinful behavior is an expression of a sinful heart (cf. Mark. 7:20-23; Proverbs. 4:23; 23:7). John Calvin said in The Institutes of the Christian Religion, “The human mind is, so to speak, a perpetual forge of idols.” We dare to imagine a god suited to our own understanding and substitute “vanity and an empty phantom” for the true God. The god whom we have thus conceived inwardly, we then attempt to embody outwardly.

Oswald Chambers said if we repeatedly run after self-serving desires, eventually they become our gods. For the addict and the alcoholic, their drugged state becomes their god. Sin in this sense is wrong being, not wrong doing. It is deliberate, emphatic independence of God:

The revelation of the Bible is not that Jesus Christ took upon Himself our fleshly sins, but that He took upon Himself the heredity of sin which no man can touch. God made His own Son to be sin that He might make the sinner a saint. All through the Bible it is revealed that Our Lord bore the sin of the world by identification, not by sympathy. He deliberately took upon His own shoulders, and bore in His own Person, the whole massed sin of the human race—“He hath made Him to be sin for us, who knew no sin,” and by so doing He put the whole human race on the basis of Redemption. Jesus Christ rehabilitated the human race; He put it back to where God designed it to be, and anyone can enter into union with God on the ground of what Our Lord has done on the Cross.

Remember that in his divine forbearance, God passes over our former sins—even those we don’t remember doing while in a blackout. This shows His righteousness, for He is the justifier of those who have faith in Jesus (Romans 3:25-26).

If you’re interested, more articles from this series can be found under the link for “The Romans Road of Recovery.” “A Common Spiritual Path” (01) and “The Romans Road of Recovery” (02) will introduce this series of articles. If you began by reading one that came from the middle or the end of the series, try reading them before reading others. Follow the numerical listing of the articles (i.e., 01, 02, etc.), if you want to read them in the order they were originally intended. This article is (06) in the series. Enjoy.

02/2/16

Groundhog Day Recovery

In the movie, Groundhog Day, Phil Connors (Bill Murray’s character) is sitting in a bar drinking with two guys, Ralph and Gus. He had just discovered that he is reliving the same day—Groundhog Day—over and over and over again. So Phil asked them: “What would you do if you were stuck in one place? And nothing you did seemed to matter?” Ralph, who was clearly drunk said: That about sums it up for me.” This and other scenes have led me to see the movie as having several allegorical scenes to addiction and recovery.

Later, after they leave the bar with Phil driving, he asked Ralph and Gus what they would do if there was no tomorrow. Gus’s answer was: “That would mean there was no hangover. We could do whatever we want.” This led to a car chase scene that ended with the three of them surrounded by the local police. There is a great moment in the scene, where Phil drove the car onto railroad tracks directly at an oncoming train. He said: “I’m betting he’s going to swerve first.” Again, this is a scene familiar to addicts and alcoholics. Putting yourself in insane situations that end with being arrested.

The hopeless repetition of the same thing over and over is an integral part of the addictive lifestyle as well as the movie. Another scene shows where Phil is trying to convince Andi McDowell’s character, Rita, that he is caught in a repetitive time loop of Groundhog Day. He tells her personal things about herself that Phil Connors, outside of the Groundhog Day time loop, wouldn’t know. Rita wonders how he’s doing this and he tells her: “ I told you. I wake up every day right here … and there’s nothing I can do about it.”

The opportunity to do whatever you want without consequences eventually turned dark for Phil. Like the addict or alcoholic, Phil misperceived what was causing his time loop and tried unsuccessfully to stop it. He said: “There is no way this winter is ever going to end as long as this groundhog keeps seeing his shadow. I don’t see any other way out. He’s got to be stopped. And I have to stop him.”

Phil then stole the groundhog and drove off the edge of a quarry. He took a bath with a toaster. He stepped in front of a car. He dived off of a building. At one point he said: “I have been stabbed, shot, poisoned, frozen, hung electrocuted and burned. . . . and every morning I wake up without a scratch on me, not a dent in the fender… I am an immortal. . . . I killed my self so many time I don’t exist anymore.”

On one of his “dry drunk” days, he sounded like some people who have railed against the perceived hypocrisy of Twelve Steppers. As he gave the introduction to the time of the groundhog’s moment of “prognostication,” Phil sounded off about his life in Groundhog Day:

This is pitiful. A thousand people freezing their butts off waiting to worship a rat. What a hype. Groundhog Day used to mean something in this town. They used to pull the hog out, and they used to eat it. You’re hypocrites, all of you!

Eventually, Phil started to see that he was powerless to change his circumstances and tried to make the best of them, often without success. He repeatedly caught a kid that fell out of a tree, but the kid always ran away without thanking him. He fed and gave money to a homeless man. He even took him to a local hospital, but the man always died. When a nurse said that sometimes people just die, Phil responded: “Not today.” And yet the man died despite Phil’s best efforts.

He repeatedly attempted to present himself in a way that would spark a romantic interest in Rita, but always ended with her slapping him. Not only was Phil powerless to change his own circumstances, he could not change those of other people—regardless of how much he may have wanted to do so.

Yet he did save Buster, the Groundhog Day emcee, from choking. He saved a young couple from breaking off their engagement And he learned to play the piano. He saw that he could make a difference if he was alert to what happened around him and used the opportunities available to him, as he took his life “one day at a time.” Even with “Needlenose Ned” Ryerson, the insurance salesman who was the bane of his existence during Groundhog Day, Phil was eventually able make it the best day of Ned’s life.

At one point in his efforts to woo Rita, he seems to have surrendered to the fact that he was not God; that he needed to live one day at a time, even if it was within his time loop. He had done an ice sculptor of Rita’s face and she told him that it was beautiful. In response, Phil said: “Whatever happens tomorrow, or for the rest of my life, I’m happy now.” When he stopped trying to manipulate the circumstances of the time loop, Rita did notice him, returned his affection and the time loop stopped. Here I was reminded of the Third Step: “Made a decision to turn our will and our lives over to the care of God as we understand Him.”

Many of the things in the movie actually do exist within the festivities of Groundhog Day in Punxsutawney. There is a Groundhog Ball. The officials at the ceremony do wear top hats. Phil (the groundhog) supposedly speaks in “Groundhogese” to the president of the Inner Circle, who then translates whether or not he predicted six more weeks of winter. Check the Punxsutawney Groundhog Day Club website for the schedule of events. You can even watch a live webcast of the festivities if you can’t get to Punxsutawney on February 2nd. Oh, and try to see the movie, even if you’re not interested in its parallels to recovery. We all need to learn to live just one day at a time.

(A blog rerun in honor of Groundhog Day)

11/13/15

From Darkness to Light

Douglas Moo said Romans 1:21 was the “missing link” for Paul’s argument in Romans 1:20, where he said those who suppress the truth God reveals about himself in creation have no excuse for their actions. “For although they knew God, they did not honor him as God or give thanks to him, but they became futile in their thinking, and their foolish hearts were darkened” (Romans 1:21). In other words, if you deny or suppress what creation reveals about God, you will never truly understand it. What’s more, your failure to understand is inexcusable because it should have been quite plain to you.

According to Robert Mounce, we can reasonably expect that knowing God should lead us to honor him as God, since He plainly gives all people the basic requirements for life, regardless of their relationship to him. Their response should be gratitude, “But people choose to ignore God and come up with their own version of reality. By rejecting the knowledge of the true God, religion is born.” Mounce’s sense of religion here seems to be a revision of Edmund/Edward Tylor’s definition of religion as follows: “the belief in spiritual beings” other than the true God. This turning from the revealed truth of God to a personal interpretation of that revealed truth has been described as “the triumph of gods over God.”

The sense of “God as you understand him” in Twelve Step recovery strikes off in two separate directions when the truth about God in creation is encountered. One is compatible with the Romans Road, and one is not. God as you understand Him is essentially “God as I am willing to accept” or “God as I am able to comprehend” Him. This first sense can be portrayed by the word “god” within a circle representing the person’s understanding. This sense of “god” becomes a projection or manifestation of a purely human attempt to explain reality.

The alternate sense, and one that is compatible with the Romans Road, is a circle of understanding that is infinitesimally smaller than God Himself. Something that looks like what follows: the representation of our understanding as a circle barely discernable with the “O” of God.

The distinction between these two “understandings” of God is illustrated in Anselm’s Ontological Argument for God’s Existence. Anselm said that even a fool can conceive of the idea of “god” as an absolutely perfect being; a being greater than anything we can imagine or conceive. But if this idea exists in our understanding, “then it can be conceived to exist in reality; which is greater.” So if someone accepts that God is greater than our ability to imagine Him, He must exist in reality because existing in reality is greater than merely existing in the imagination. “Hence, there is no doubt that there exists a being, than which nothing greater can be conceived, and it exists both in the understanding and in reality.” Brian Davies and G. R. Evans noted in Anselm of Canterbury: The Major Works that Anselm believed:

God cannot be thought of simply as a concept people have. He [Anselm] thinks people who deny God’s existence can nevertheless be thought of as having some concept of God, for so he says, they have some idea of what it is whose existence they deny.

If reflecting on the meaning of the word ‘God’ shows that God necessarily exists in reality and not just in the mind as an idea of him, then someone who denies there is a God is ultimately proposing what must necessarily be false. Anselm saw his argument for the existence of God as paving the way for serious reflection on what we mean when we use the word ‘God.’ He also believed his ‘proof’ showed that God was what Christians believed God to be. But according to Romans, if this knowledge doesn’t lead the individual to honor and give thanks to God, it is not saving knowledge of God (Romans 1:16, 21).

So if this knowledge does not lead to reverence and gratitude towards God, then it “falls far short of what is necessary to establish a relationship” with God. In Romans 1:21 Paul points to what will happen with an understanding of God based solely on the knowledge of God revealed in creation—your thinking becomes futile; and your foolish heart becomes darkened. Whatever your initial capacity to reason about God may have been, whatever initial knowledge of creation you might have had, failing to acknowledge God’s hand in it means your thinking about it will ultimately be in vain; futile.

You can understand God to be greater than your ability to imagine Him, but still not have that knowledge lead you to worship Him. It requires the light of the gospel. Knowledge of God that does not lead you to honor and give thanks to Him leads to futile thinking and darkened, foolish hearts. Douglas Moo commented that at the very center of every person where the knowledge of God must be embraced is darkness. If the knowledge of God is to have any positive effects, then only the light of the gospel can penetrate that darkness.

As Paul has already said in verse 1:18 of Romans, the wrath of God is revealed against individuals who suppress the truth of what God has revealed. You need more than just an understanding of God as a being greater than anything we can imagine or conceive to have a relationship with “the God of the preachers.” John Calvin said of the individuals Paul described in Romans 1:21, “They quickly choked by their own depravity the seed of right knowledge, before it grew up to ripeness.” Robert Mounce put it this way:

To turn from the light of revelation is to head into darkness. Sin inevitably results in a darkening of some aspect of human existence. In a moral universe it is impossible to turn from the truth of God and not suffer the consequences. Ignorance is the result of a choice. People who do not “know” God are those who have made that choice. Understanding God requires a moral decision, not additional information.

According to the Reformation Study Bible, God will not allow human beings to entirely suppress their sense of God. Even in a fallen world people have a conscience; they have some sense of right and wrong. “When conscience speaks in these terms it speaks with the voice of God.” And I think this is true for the Twelve Steps. By meditating on what ‘God as I understand Him’ means, perhaps someone will have a deeper appreciation of what Christians believe God to be.

If you’re interested, more articles from this series can be found under the link for “The Romans Road of Recovery.” “A Common Spiritual Path” (01) and “The Romans Road of Recovery” (02) will introduce this series of articles. If you began by reading one that came from the middle or the end of the series, try reading them before reading others. Follow the numerical listing of the articles (i.e., 01, 02, etc.), if you want to read them in the order they were originally intended. This article is “04,” the fourth one in the series. Enjoy.

09/7/15

Preventing and Stopping Cravings

Not all addicts and alcoholics struggle with cravings in recovery. And not all addicts and alcoholics experience them with the same intensity. But knowing how to recognize the sets ups and triggers for a craving are crucial skills for those in recovery who do experience them. Otherwise, it’s like living through a drug and alcohol-themed version of Groundhog Day.

On his blog, Terence Gorski described a three-stage model to manage cravings without them leading back to active drug or alcohol use. Two previous articles “Ready to Cope with Cravings” and “Getting Set to Cope with Cravings” reviewed the three stages of Gorski’s model to understand cravings. This final article of the three part series describes how to prevent cravings and stop them once they do occur.

Craving is not an inevitable process. They can be prevented if you follow a few simple guidelines. And they can be managed without a return to active drug use. Gorski suggested five preventive measures against craving.

First, develop and maintain a structured recovery program that keeps you in regular, continuous, daily contact with other recovering people.
Second, know what your triggers are. “Identify the things that activate the craving and learn how to cope with those triggers.”
Third, know and avoid your set-up behaviors; learn how to cope with them if you can’t avoid them.
Fourth, dismantle euphoric recall—intentionally include where the “fun” of the high will eventually lead you. Remember where it took you in the past.
Fifth, stop awfulizing sobriety and put an end to magical thinking.

Despite your best efforts, you may still experience cravings. Remember that they are a normal symptom experienced by most addicts in recovery. While there are a fortunate few who have minimal or no problems with cravings in early recovery, they are the exception, not the rule. So if you have cravings, stop them from leading you back to active drug use by practicing a few simple steps.

First, recognize the craving. This may seem obvious, but sometimes the craving is mild and appears to be something you can “white knuckle” it through until it’s over. “Many addicts fail to identify mild craving as problematic and wait until they are full-blown, severe cravings before taking action.”
Second, don’t panic if you have one. Remember that cravings are normally experienced by addicts in recovery. It doesn’t mean you are doomed to resume active drug use or that you aren’t doing enough for your recovery.
Third, get away from where you are. A craving might be activated by an environmental trigger. You may have thought a situation wouldn’t be a trigger, only to discover once you are in it, that it triggers you. GET OUT OF THERE and go to “an environment that supports recovery.”
A fourth step you can take is to talk the craving cycle through with someone. “If you talk it through, you don’t have to act it out.” Honestly talking the process through from beginning to end can discharge the urge to use because you are mentally removing yourself from it. It’s like you have a video of the process that you are reviewing. You stop, rewind, fast-forward, and go frame by frame with the recording of what happened to discover the timeline and cause-and-effect chain reaction of what led to the craving.
Fifth, distract yourself. Divert attention from the craving by engaging in other productive, positive activities that require your full attention.
You could do some aerobic exercise, a sixth action step to cope with cravings. Aerobic exercise can stimulate brain chemistry that reduces cravings.
Seventh, you can try meditation or relaxation. Cravings are often intensified under high stress. “The more a person can relax, the mower the intensity of the craving.”
Eighth, you can eat a healthy meal to nourish your brain.
Ninth, remember they are time-limited and will eventually pass. Most cravings won’t last more than two or three hours. If you persist in the steps suggested here to the point of getting fatigued enough to fall asleep, many people wake up with the craving gone.

It is possible to understand drug craving and to learn how to manage craving without returning to use. A model that allows people to identify set-up behaviors, trigger events, and the cycle of craving itself, and intervening upon this process has proven effective in reducing relapse among addicts.

I have read and used Terence Gorski’s material on relapse and recovery for most of my career as an addictions counselor. I’ve read several of his books and booklets; and I’ve completed many of his online training courses. He has a blog, Terry Gorski’s blog, where he graciously shares much of what he has learned, researched and written over the years. You can access additional articles stemming from Terence Gorski’s material under the Gorski link on Faith Seeking Understanding.

Faith Seeking Understanding

Charles Sigler, D.Phil.

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